Lower Bleph with Fat Removal vs. Repositioning - which would be more effective? (photos)

Question

I am looking to have my undereye bags treated with a lower blepharoplasty. I have had two consultations where one doctor recommended fat removal and the other recommended fat repositioning. I would appreciate any insight on which procedure would be more effective.

Mark McRae, MD · Answer

Unfortunately there have been no definitive studies performed to answer this question. I am part of a team that is developing patient reported outcomes measures to help measure patient satisfaction after facial aesthetic treatments. Hopefully we will have real data to answer this question for you in a few years. 
That being said to address your problem fat removal versus redistribution is only one piece of the solution.
There are several things that must be addressed here to ensure an excellent result.What is this caused by?:There is a ligament that tethers the skin at the junction of your cheek and eyelid (arcus marginalis). There is fat that pushes out from within your globe that is held back by a structure called the orbital septum. There is fat in the cheek and face that descends as a normal aspect of aging. There are medical conditions that make swelling worse, or the contents of the globe push out more. These should be addressed if present and will be discussed with your plastic surgeon.Treatment:There are multiple approaches to treat this condition surgically.The structures can be approached either directly through the skin crease or within the eyelid.The ligament must be released.The fat prolapsing needs to be adjusted, sculpted, blended and in some cases removed to ensure the best cheek contour possible.Finally your lower eyelid must be supported, and muscles tightened to ensure your eyelid heals well and in the correct position.
Over the years I have moved more and more into fat preservation and redistribution. Fat is precious in the face after all. However I also customize it to the patient. If you have prominent bone structure in comparison to your eye (deeper set eyes), I never remove fat. If your cheek is very recessed in comparison to your globe, and the fat doesn't blend adequately into your cheek, I will remove some fat conservatively at the time of surgery- think of it as sculpting what is there for shape more than removing.
There are many ways to treat your concern and even though I am a craniofacial expert, I cannot say that my approach is right and the other approaches are wrong. Not until the science catches up to the art can I say this to you with a clean conscience. Therefore choose the surgeon that you trust and have a good relationship with. Ideally someone with experience and that also keeps up with the science. Both the surgeons you have seen may get you the result that you are looking for.
Please make sure they are a board certified plastic surgeon!

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As soon as I can see from your photos you have eye bag under your eye areas and your eye corners are very downward. For get rid of the eye bags and gain more upward, elegant, slanted look I recommend you cat eye procedure and lower eyelid blepharoplasty. It would be more convenient to decide with face-to-face consultation. Best Regards!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. During a lower blepharoplasty procedure, fat is often repositioned to add volume to key areas around the eye and create a supple, more symmetrical result. Fat from the eye bags may also be repositioned into the upper cheek to fill in hollows and ensure a smooth transition between the lower eyelid and upper cheek area. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who will answer any questions you may have and describe which steps would best help you achieve your aesthetic goals.

C. Blake Perry, MD · Answer

There is no right or wrong answer to this question. Typically in my hands, you would be a good candidate for fat transposition surgery. This would help fill the tear trough and anterior medial cheek to avoid looking sunken after the surgery.

Kerem Sami Kaya, MD · Answer

Hi,Both procedures can be done according to the patients’ problems. But I prefer fat reposition in all my surgeries, if I think there is a little fat excess after reposition, then I can do very little fat removal. It is important that you could manage the process with a competent surgeon. I wish you a good surgery process.Have a nice day.

Andrea Lora Kossler, MD, FACS · Answer

There are many options for eyelid surgery. I recommend you select a surgeon who specializes in eyes to ensure you have the most natural and safe results. Based off your photos, you have mild fat herniation (also called lower lid bags) with a dark circle (also called tear troughs) underneath the bag, and a little mid face volume deflation. You are a good candidate for a transconjunctival (no visible incision) lower lid blepharoplasty with fat transposition. The incision is made behind the eyelid and the lower lid fat is repositioned into the dark circle to fill the volume deflation between the eyelid-cheek junction. Fat removal alone, without transposition, is an option for some patients, however, I feel it will make your dark circles more noticeable and your lower lids look more hollow. I also recommend a canthopexy at the time of your lower lid blepharoplasty. Based on your photos, the corners of your eyes appear slightly downturned. A canthopexy can improve the the angle of your eyelid to give you a natural almond shaped appearing eyelid. The incision can be hidden in your eyelid crease. This can also improve tearing and your lower lid position as you age. You have several options, it is most important to find someone you trust and explains things clearly so you know what to expect and your concerns are addressed.

Soon-Dong Kim, MD · Answer

There are several surgical treatments for eyebags such as Transconjunctival Fat Removal, Transconjunctival Fat Reposition and Lower Blepharoplasty. Depends on your age and sagging skin, we recommend lower blepharoplasty. But your case, the wrinkles and sagging skin are not that severe so we recommend Transconjunctival Fat Reposition which removes the fat under the eyes and re-fix the septum surrounding the fat under the eyes.
Before the surgery, better to find a board certified surgeon and have a consultation first.

William Portuese, MD · Answer

In our practice, we perform fat removal to rejuvenate the lower lids. Fat repositioning doesn't work very well because the fat usually doesn't stay put in the place that it is sewn down to. The fat is removed through two small incisions on the inside of the lower lid, and there's no external incisions.

Camille Cash, MD · Answer

Both procedures can be beneficial.  It is important that if fat removal is elected that not too much is removed or you can end up with a hollow look to the under eye.  I encourage you to discuss your concerns with the surgeons as well as look at before/after photos of their previous patients.

Lower Bleph with Fat Removal vs. Repositioning - which would be more effective? (photos)

Answers (9)

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